New in Breast Cancer
Dr. Omar Sherif Omar
Professor of MD (PhD), DU, FEBS, FACS
A. professor & Consultant of Oncoplastic Breast Surgery – Cairo University
Faculty & Examiner – European Board of Oncoplastic breast surgery
Medical director – Arab Breast & Cancer Care
Breast cancer management has passed through many changes and modifications over the previous four decades , there is the development in diagnostic tools for breast cancer like the introduction of digital technology for the breast mammogram, as well as the emergence of the role of MRI in the diagnosis of breast disease.
Nowadays, there has been a major development in the techniques of optaining tissue samples from the breast. it became mandatory for us as consultants to know clearly the difference between the sampling techniques and to choose the appropriate method for the patient, sampling methods varies like: fine needle aspiration, tru cut biopsy, mammotome and sampling the whole mass with local anesthesia which is known as the BLES (Breast Lesion Excision System )
Recently these samples have been taken with the guidance of ultrasound, which increases the accuracy of the sample. Nowadays breast ultra sonography has an integral role in breast screening and sampling, this has widened the scope of training on breast diagnostics all over the world, particularly for breast surgery specialists, Diagnostic Radiology plays bigger role in helping surgeons to determine the exact tumor size to be removed by placing a wire to localize the tumor site (wire Localization) thus helping the surgeon to remove the tumor more precisely, in regards of tumor identification it has become a universal practice to apply an (Identification Clip) into the tumor especially for patients who had chemotherapy before surgery, this clip helps to locate the tumor which is vital to the success of the surgery specifically in patients who had an excellent response to chemotherapy with complete disappearance of the tumor, without identification clips the Surgery becomes not precies and may require sometimes removing excessive amount of breast tissue or maybe removal of the entire breast.
The development of breast cancer management has included other areas, we are currently living a great development in the field of histolopathological examination of breast tumors, breast is nowadays divided into several types according to the histopathology examination
and immuno histo chemistry. this in turn means different treatment plans depending on the biological type of the cancer, the pathology examination of the tumor is considered the ID card of the tumor that will help the treating physician in developing the treatment plan and the follow-up protocol. Nowadays we depend on the histological examination of tissue during surgery by the pathology specialist (frozen section), this should be done by skilled and experienced pathologist to be able to reach the appropriate diagnosis in this short time.
However, the real development that has occurred in the field of breast cancer treatment are the major developments in the treatment and quality of surgical procedures provided to patients, the concept of surgical treatment for breast cancer has changed completely, the concept of training also changed and became more dependent on modern techniques and high surgical skills, leading to the start of a new specialty in the treatment of breast cancer namely; Breast Oncoplastic surgery.
In this specialty the surgeon is trained to the highest degree in the surgical practice in treating breast cancer, according to the international oncology principles and using the skills and techniques that are used in breast plastic & reconstructive surgery, breast cancer patients nowadays could be treated surgically and get more beautiful breasts than it was before the operation without affecting the breast cancer therapy, moreover these surgical techniques have allowed for more safe margins of tumors increasing the precision of surgical treatment provided.
This means better cancer treatment & better cosmetics
In regards of the lymph nodes excision it is not acceptable these days to excise lymph nodes without being absolutely sure of the inevitability of removing them, there are now a group of patients may be excluded from the complete removal of the lymph nodes with its subsequent complications , by identifying the first lymph node ( sentinel lymph node biopsy) by modern means of identification during the surgery for example radioactive isotopes, which is the common practice used in all specialized centers in Europe and America.
The concept of breast cancer management has changed significantly, It requires teamwork and collaboration between all parties involved in providing the treatment , the multidisciplinary team includes oncoplastic surgeons, medical oncologists, breast radiotherapist, breast radiologists, breast pathologist, plastic surgeons, anesthesia and pain management specialists, physiotherapy specialist and breast psychotherapists.
The world has witnessed great development in the evaluation of specialized centers which offer treatment of breast cancer, It became necessary that the centers are equipped with means of diagnosis of breast as mammography and X-Ray, as well as high technologies in the pharmaceutical and the provided chemotherapy treatment, but the main pillar remains the presence of the multidisciplinary medical team in one place working as one unit.
The world is constantly evolving and there are always new development, both in diagnosis and treatment, we are heading to the concept of specialization and the support of specialized centers, as well as specialized education, training and degrees, such as, for example, European Board in breast surgery (Ph.D. specialized in breast).
We are sure that there are developments occurring daily in the field of breast cancer, and keeping up with these developments as well as hard work is the key to ensure the provision of therapeutic services of high quality and highly accuracy.